MyMedR

Rajakumar MK

Malays Fam Physician, 2006;1(1):4.

Fulltext Urinary frequency: going beyond the tract

Rahmat R

Malays Fam Physician, 2020;15(1):58-60.

Obsessive-compulsive disorder (OCD) is a common anxiety disorder which can be chronic and sustained. An OCD sufferer experiences intrusive and repetitive thoughts, impulses, and behaviors, which ultimately cause extreme discomfort. We report a case of a patient that primarily presented with lower urinary tract symptoms who was subsequently treated with antibiotics. Nonetheless, the symptoms persisted. In subsequent consultations, the patient clarified the compulsive nature of his symptoms and was treated as a case of OCD. Therefore, it is crucial for physicians to correctly identify the nature of the symptoms to manage the disorder properly and to avoid unnecessary consultation and treatment. To the best of our knowledge, this is the first report of other presentations of OCD.

Fulltext Ptosis due to cavernous sinus syndrome as a rare presentation of advanced breast metastasis in a patient with delayed diagnosis

Khaw K, Ramli N, Rahmat K

Malays Fam Physician, 2012;7(1):31-3.

PMID: 25606243 MyJurnal

Complications of breast cancer metastasis may be the first manifestation of the disease. We report a rare case of left eye ptosis secondary to cavernous sinus syndrome in a 34-year-old lady due to refusal of proper medical treatment for metastatic breast cancer. The delay in seeking medical treatment was attributed to her use of Traditional Chinese Medicine (TCM).

Fulltext Ludwig's angina: the importance of oral cavity examination in patients with a neck mass

Mohamad I, Zulkifli S, Soleh M, Rahman R

Malays Fam Physician, 2012;7(2-3):51-3.

PMID: 25606258 MyJurnal

Neck mass is a common condition in primary care. The most common affected area is the cervical lymph node. The neck region is also prone infection as structurally the nodes and spaces are in close contact with the upper respiratory tract and the alimentary tract. Oral cavity is one of the most common route for harbouring infection. Poor oral hygeine and periapical dental problems are the main causes. Thus, it is important to perform a complete oral cavity examination even when trismus is present. Besides dental caries, floor of the mouth should be inspected for oedema that may impose threat to the upper airway. We report a case of Ludwig's angina originating from a periapical lesion of the lower molar stressing the importance of oral examination in patient with neck mass.

Fulltext Psychological morbidities among spouses of men with type 2 diabetes mellitus and erectile dysfunction in a primary care setting

Nazeera Fatimah K, Zuhra H, Hizlinda T, Noor Azimah M, Syahnaz MH, Rahmah K

Malays Fam Physician, 2023;18:44.

PMID: 37575358 DOI: 10.51866/oa.333

INTRODUCTION: Erectile dysfunction (ED) negatively affects patients' emotions. However, its effect on spouses' psychological well-being remains largely unknown. This study aimed to examine psychological morbidities and their associated factors among spouses of men with type 2 diabetes mellitus (T2DM) and ED.

METHOD: This cross-sectional study included 115 women recruited through their husbands who were patients at a selected government health clinic in Malaysia. A self-administered questionnaire containing the Depression Anxiety and Stress Scale-21 and items on health-related information, marital history, sexual history and perception of husband's ED was used to assess possible depression, anxiety and stress.

RESULTS: The prevalence of psychological morbidities was 28.7% (depression=17.4%, anxiety=25.2% and stress=10.4%). Most respondents were middle-aged [median (interquartile range)=44.0 (11.0) years], were employed (55.7%) and had a low income (81.7%). About 47.0% of the spouses had a medical problem. The mean marriage duration was 18.7 (standard deviation=7.9) years. Almost all (90.4%) had sexual intercourse (SI) within the previous month. The majority had moderate-to-high interest in SI (72.2%) with a frequency of one to two times per week (69.6%). The majority (75.7%) did not perceive their husband as having ED. Multiple logistic regression demonstrated that medical illness was significantly associated with anxiety (adjusted odds ratio=2.85, 95% confidence interval=1.11-7.29, P=0.029).

CONCLUSION: Psychological morbidities were present among the spouses of men with T2DM and ED. Psychological well-being was significantly affected by their medical illness. Despite their husband's ED, the women declared to have regular sexual relationships and did not perceive their husband as having erectile problems.

Fulltext Referral patterns and outcomes of children who failed Modified Checklist for Autism in Toddlers screening during routine health screening at maternal and child health clinics in the northeast district of Penang: A retrospective cohort study

Ambigapathy R, Ramachandram S, Rahim FF

Malays Fam Physician, 2024;19:9.

PMID: 38496769 DOI: 10.51866/oa.378

INTRODUCTION: Autism spectrum disorder (ASD) is a developmental disability that causes significant social, communication and behavioural challenges. The Modified Checklist for Autism in Toddlers (M-CHAT) is a parent-administered screening questionnaire for ASD used at 18 and 36 months of age. This study aimed to determine the outcomes of children who failed M-CHAT screening during routine health screening at maternal and child health clinics in northeast district, Penang and the prevalence of ASD among those with a final diagnosis.

METHODS: This retrospective cohort study was conducted at 12 maternal and child health clinics. All children who failed M-CHAT screening at 18 and 36 months from January 2017 to December 2021 and received a final diagnosis before 31 March 2022 were recruited. All information required was recorded in a data collection form and analysed using SPSS. Multiple logistic regression was performed to assess the association between the factors and ASD status.

RESULTS: Eighty-two children failed M-CHAT screening. Fifty children did not receive a final diagnosis. Among 32 children who received a final diagnosis, 25 were diagnosed with ASD (78.1%). Among the children who underwent M-CHAT screening, the odds of having ASD increased by a factor of 1.2 for every 1-unit increase in age at final diagnosis.

CONCLUSION: In northeast district, Penang, more than half of children who fail M-CHAT screening have no final diagnosis. The specificity of the M-CHAT is 78.1% among children with a final diagnosis of ASD. The age at final diagnosis is positively associated with the diagnosis of ASD.

Fulltext A man with hot potato voice and neck swelling

Irfan M, Puvan Arul A

Malays Fam Physician, 2012;7(1):41-2.

PMID: 25606246 MyJurnal

Fulltext Fever and rash in an 11-month-old girl

Jamani NA, Puteri Shanaz JK

Malays Fam Physician, 2016;11(1):15-17.

PMID: 28461843

Fulltext Primary tuberculosis of palate

Chen I, Jamal S, Pua KC

Malays Fam Physician, 2015;10(3):32-4.

PMID: 27570606 MyJurnal

Primary tuberculosis (TB) of the hard palate is very rare. A 74-year-old man was presented with 6-month history of dysphagia along with an irregular mass in the hard and soft palate. Magnetic resonance imaging (MRI) revealed thickened and increased signal intensity within hard and soft palate. Tissue biopsy showed focal caseating granulomatous-like lesion and the histochemical staining using Ziehl-Neelsen stain for acid-fast bacilli was positive. Positive histochemical studies provided evidences that the hard palate mass was most likely due to TB. Thus, the patient was started on antituberculous therapy.

Fulltext Facial nerve palsy in a child: Bell’s palsy? Think again!

Jo Ee Sam, Nasser Abdul Wahab, Priya Sharda

Malays Fam Physician, 2017;12(3):30-32.

MyJurnal

Introduction: Half of facial paralysis in children is idiopathic at origin. However, dismissing facial
paralysis as being idiopathic without a thorough history and meticulous examination could be
disastrous as illustrated by this case.

Case report: We report a case of sphenoid wing meningioma in a 4-year-old girl. She first
presented with only facial asymmetry that was noticed by her mother. Examination suggested a
left upper motor neuron facial nerve palsy. A sphenoid wing meningioma was found on magnetic
resonance imaging (MRI) of her brain. She underwent craniotomy and total tumour excision.
Histopathological examination of the tumour showed a grade 1 transitional type meningioma.
Meningiomas in children are rare compared to the adult population. Presentations in children
may be delayed due to their inability to recognise or communicate abnormalities. Distinguishing
between upper and lower motor neuron facial palsy is crucial in decision making for facial paralysis
in children.

Fulltext Management of chronic heart failure in primary care: What evidence do we have for heart failure with preserved systolic function?

Ramli AS, Jackson B, Toh CT, Ambigga Devi SK, Piterman L

Malays Fam Physician, 2010;5(2):68-76.

PMID: 25606191 MyJurnal

Chronic Heart Failure (CHF) is a debilitating illness commonly encountered in primary care. Its prevalence in developing countries is rising as a result of an ageing population, and an escalating epidemic of hypertension, type 2 diabetes and coronary heart disease. CHF can be specifically diagnosed as Heart Failure with Reduced Systolic Function (HF-RSF) or Heart Failure with Preserved Systolic Function (HF-PSF). This paper illustrates a common presentation of HF-PSF in primary care; and critically appraises the evidence in support of its diagnosis, prognosis and management. Regardless of the specific diagnosis, long term management of CHF is intricate as it involves a complex interplay between medical, psychosocial, and behavioural factors. Hence, there is a pressing need for a multidisciplinary team management of CHF in primary care, and this usually takes place within the broader context of an integrated chronic disease management programme. Primary care physicians are ideally suited to lead multidisciplinary teams to ensure better co-ordination, continuity and quality of care is delivered for patients with chronic conditions across time and settings. Given the rising epidemic of cardiovascular risk factors in the Malaysian population, preventive strategies at the primary care level are likely to offer the greatest promise for reducing the growing burden of CHF.

Fulltext Training program in the field of addiction medicine - an experience of learning while abroad

Norsiah A, Whelan G, Piterman L

Malays Fam Physician, 2008;3(1):61-3.

PMID: 25606116

This paper illustrates the training program in the field of Addiction Medicine designed for primary care doctors by the Department of General Practice, School of Primary Care at Monash University in Melbourne. The nine month program was based around coursework, field visits and clinical observations. There were five modules that were completed and passed, twenty six Continuous Medical Education sessions attended, twenty nine field visits on Drug & Alcohol services, forty seven clinical visits and a total of three hundred and sixty clinical observations made. The comprehensive training program has benefited the first author in several ways to improve the Drugs & Alcohol services in Malaysia.

Fulltext Rejuvenating chronic disease management in Malaysian private general practice - a global perspective

Anis Safura R, Wijesinha S, Piterman L

Malays Fam Physician, 2010;5(1):49-52.

MyJurnal

Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper re-examines the current evidence supporting the implementation of Wagner Chronic Care Model in primary care globally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT (strengths, weaknesses, opportunities and threats) analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.

Fulltext The child with suspected hearing loss

Philip R

Malays Fam Physician, 2013;8(2):65-66.

PMID: 25606288 MyJurnal

An 8-year-old girl was noticed by her parents to be less attentive and she would respond only after being called several times. She had just recovered from an upper respiratory tract infection two weeks before. The parents brought her to see a primary care physician. The patient had no other complaints, and the rest of the history was unremarkable. Physical examination was normal except for the otoscopic findings shown below (Figure 1) Tuning fork tests indicated conductive deafness.

Fulltext Hot water immersion as a treatment for stonefish sting: A case report

Darlene FO, Phee-Kheng C

Malays Fam Physician, 2013;8(1):28-32.

PMID: 25606265 MyJurnal

The North Borneo state of Sabah is known worldwide for its beautiful islands and dive sites. Local hospitals deal with a number of marine-related injuries, including marine fauna envenomation by Scorpaenidae and Synanceiidae families of fish. We report a case of a tourist who presented with excruciating pain on her right foot after stepping on a stonefish. Despite being given parenteral analgesia and regional anaesthesia, the pain persisted. Her pain improved after she soaked her foot in hot water for about 30 minutes. No further treatment was required. We reviewed the literature comparing this inexpensive mode of treatment with other conventional treatments. We also explored the possibility of using hot water immersion for treatment of envenomation by other types of marine animals.

Fulltext Depression in primary care, Part 1: Screening and diagnosis

Zainab AM, Pereira XV

Malays Fam Physician, 2007;2(3):95-101.

PMID: 25606093 MyJurnal

One of the commonest psychological problems that a clinician would encounter in primary care is depression. The prevalence of depression is high in women, the elderly and those with underlying physical problems or during the postpartum period. The spectrum of clinical presentations is wide and somatic complaints are more common in primary care clinics. Depression may present as a primary disorder and co-morbidity with other psychological problems or physical illnesses is high. A good clinical interview is an important form of assessment and a quick screening of depression can be done with the administration of proper rating scales, such as the Patient Health Questionnaire, Hamilton Depression Rating Scale or Geriatric Depression Scale. Repeated use of the same scale in a patient would help the clinician to monitor the progress objectively.

Fulltext A boy with prolonged Fever

Pau W

Malays Fam Physician, 2008;3(3):162.

PMID: 25606144

Fulltext The feasibility of a public-private mix program on pulmonary tuberculosis screening in Penang: A pilot study

Tang WS, Chan MW, Kow FP, Ambigapathy R, Wong JHW, Thiruvengadam V, et al.

Malays Fam Physician, 2021 Mar 25;16(1):75-83.

PMID: 33948145 DOI: 10.51866/oa1096

Background: The low detection rate of tuberculosis (TB) cases in Malaysia remains a challenge in the effort to end TB by 2030. The collaboration between private and public health care facilities is essential in addressing this issue. As of now, no private-public health care collaborative program in pulmonary tuberculosis (PTB) screening exists in Malaysia.

Aim: To determine the feasibility of a collaborative program between private general practitioners (GPs) and the public primary health clinics in PTB screening and to assess the yield of smear-positive PTB from this program.

Methods: A prospective cohort study using convenient sampling was conducted involving GPs and public health clinics in the North-East District, Penang, from March 2018 to May 2019. In this study, GPs could direct all suspected PTB patients to perform a sputum acid fast bacilli (AFB) direct smear in any of the dedicated public primary health clinics. The satisfaction level of both the GPs and their patients were assessed using a self-administered client satisfaction questionnaire. IBM SPSS Statistical Software was used to analyze the data.

Results: Out of a total of 31 patients who underwent the sputum investigation for PTB, one (3.2%) was diagnosed to have smear-positive PTB. Most of the patients (>90%) and GPs (66.7%) agreed to continue with this program in the future. Furthermore, most of the patients (>90%) were satisfied with the program structure.

Conclusion: It is potentially feasible to involve GPs in combating TB. However, a more structured program addressing the identified issues is needed to make the collaborative program a success.

Fulltext Achieving sustainable development goals with primary care physicians

Wong PF, Lee WK, Paranthaman V

Malays Fam Physician, 2024;19:1.

PMID: 38371723 DOI: 10.51866/ed0008

Fulltext Close contact investigation of TB in high-burden, low- and middle-income countries

Pang YK

Malays Fam Physician, 2014;9(2):11-17.

PMID: 25893066 MyJurnal

Tuberculosis (TB) remains a very common disease in most of the low- and middle-income countries. As a result of high disease burden, TB control measures in these countries are usually concentrated on intensifying active disease case-finding and early treatment of infectious TB. On the contrary, in countries with low disease burden, the focus is on contact investigation to identify latently infected individuals and prophylactically treating them to prevent disease reactivation and transmission. These two strategies are deemed important for the effective TB control. Nonetheless, WHO cautions that targeted contact investigation and latent TB infection (LTBI) treatment should only be undertaken by countries that have the operational capacity/ resources and have achieved ≥ 85% treatment success rate of active TB. The screening of LTBI is further challenged by the lack of a “gold standard” test to identify and validate individuals with this condition. Tuberculin skin test (TST) is still the preferred investigation as it is cheap, widely available and validated in many trials. The sensitivity and specificity of the newer test—interferon gamma release assay (IGRA) for LTBI screening has been encouraging in low prevalence countries. However, the evidence supporting such usage remains uncertain in high burden settings. Diagnosis of LTBI should adhere to the strict criteria outlined in the guidelines to avoid misdiagnosing active TB as LTBI. The treatment of the latter involved only one or two anti-TB drugs. It has been demonstrated that in the properly conducted contact screening and LTBI treatment, chances of the emergence of multi-drug-resistant TB is very low.

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